Impact of Prenatal Care Coordination on Birth Outcomes in Wisconsin

Background:

This paper explored the impact of one population-oriented approach, Prenatal Care Coordination (PNCC), on healthy birth in the state of Wisconsin. PNCC, a comprehensive program of case management and health education for pregnant women, was established as a Medical Assistance benefit in 1985 to address the nation's persistent and disparate rates of infant mortality and its associated costs. This benefit was adopted and implemented by Wisconsin in 1993. Limited evaluation of the Wisconsin program has occurred since that time.

PNCC interventions are delivered with the framework of Evans & Stoddart's (1994) determinants of health model which focuses on strengthening social and physical environments and the mother's individual response to decrease the incidence of poor infant outcomes. Public health nurses are one of the major PNCC provider groups in Wisconsin. This study not only looked at the impact of PNCC services on infant outcomes, but also investigated the impact of the intensity of service on these outcomes.

Methods:

A secondary analysis of the 2001-2 Wisconsin Birth Linked Dataset (N=45,406) was conducted. This dataset links all Medicaid recipients' birth certificate data with Medicaid billing data. A cross sectional design was used to compare the infants born to women who received Medicaid and PNCC services (N=10,715) to infants born to women who received Medicaid and did not receive PNCC services (N=34,691). Binary logistic regression analyses were conducted to evaluate impact on three different outcome variables—birth weight, gestational age, and transfer to Neonatal Intensive Care Units (NICU's). Within the PNCC service group, further analyses were conducted to measure the intensity of service—using both timing of entry into PNCC services and number of hours of service—on the same infant outcomes.

Results:

Women who received PNCC had fewer low birth weight babies, fewer premature babies, and fewer infants transferred to NICU's. Women who had more hours of service also had fewer infants with poor birth outcomes.

Conclusions:

PNCC is an effective strategy in preventing low birth weight and premature infants and NICU transfers. Strategies to further improve the quality and impact of the PNCC intervention are worthy of further investigation.